Provider Demographics
NPI:1407310105
Name:STOKES, MELISSA (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:STOKES
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 N MCKINLEY AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-3071
Mailing Address - Country:US
Mailing Address - Phone:719-357-2083
Mailing Address - Fax:
Practice Address - Street 1:1 OHIO UNIVERSITY
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2942
Practice Address - Country:US
Practice Address - Phone:719-357-2083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-26
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
OHAT0059542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer